Special Needs Plans: Considerations for Skilled Nursing Facilities
Managed Care is rapidly assuming a major role in skilled nursing facility (“SNF”) reimbursement. Traditional Medicare Advantage penetration is now 30% nationally, with many markets exceeding 60% enrollment. Participation continues to grow unabated, with overall enrollment doubling in the past seven years. Meanwhile, several states have moved to Managed Care for SNF Medicaid beneficiaries, and at least a dozen more are in various stages of adoption. Even the Medicare fee-for-service (“FFS”) program is implementing managed care principles through Accountable Care Organizations and the Bundling demonstration. The only remaining segment of the SNF business that remains almost exclusively FFS is Medicare (Part A and Part B) for the long-term care population, as these residents are generally not financially conducive to traditional Medicare Advantage. But now after more than 10 years in existence, Special Needs Plans (“SNPs”) are finally gaining traction in managing these beneficiaries as well.
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Medicare Advantage: Avoiding Common Pitfalls
The Medicare Advantage (“MA”) program is growing rapidly and now represents over 30% of all Medicare beneficiaries nationwide, an increase of more than 10% over the past two years. This ratio means that almost one in three beneficiaries admitted to our facilities are now covered by a private insurance company instead of the traditional fee-for-service (“FFS”) program. This poses a significant threat to our finances, as MA rates are, on average, less than 80% of FFS rates (MedPAC). MA admissions are also more administratively challenging than FFS, as plans aggressively case-manage benefits to control expenses.
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